The effect of insomnia correction on the duration and severity of headaches

Introduction. Chronic tension headache and insomnia are a common mutually aggravating pathology. Drugs used to treat these nosologies most often worsen the course of the concomitant disease.

Objective. To evaluate the effect of insomnia correction on the intensity and frequency of headaches

Materials and methods. The study involved 27 patients (25 women, 2 men) with chronic tension-type headache and sleep disorders. The median age was 43 ± 14.8 years. In accordance with the purpose of the study, the clinical group was divided into 2 subgroups. The first group was treated with venlafaxine and doxylamine, the patients of the second group received only venlafaxine treatment. The assessment was carried out before the start of treatment and 8 weeks after, using visual analogue scales for headache, sleep, health status, assessing the severity of insomnia using the Morin scale and the Pittsburgh Sleep Quality Inventory (PSQI), assessing the emotional state using the Sheehan anxiety and Beck depression scales and polysomnography.

Results. In subgroup 1, which received correction of insomnia, there was a significant decrease in the number of days with headache (from 20 to 10, p = 0.002), pain intensity according to VAS (from 7 to 6, p = 0.01) and VAS sleep (from 6 to 4 points, p = 0.003). In the group without correction of insomnia, the number of days with headaches significantly decreased (from 15 to 12, p = 0.01), changes in the severity of headache according to VAS (from 7.5 to 6, p = 0.13) and sleep quality (from 6 to 7.5, p = 0.38) did not have a statistically significant difference. According to the results of polysomnography, patients who received correction of insomnia had an increase in the duration of slow-wave sleep by 12 minutes (p = 0.02), while in patients from the second subgroup by 4 minutes (p = 0.68).

Conclusions. The use of a combination of venlafaxine and doxylamine in the first stages of treatment of patients with chronic tension-type headache and insomnia has an advantage over standard therapy. Combination therapy can reduce the intensity and frequency of headaches and improve sleep quality.

1. Sancisi E, Cevoli S, Vignatelli L, Nicodemo M, Pierangeli G, Zanigni S et al. Increased prevalence of sleep disorders in chronic headache: A сase-сontrol study. Headache. 2010;50(9):1464–1472. https://doi.org/10.1111/-j.1526-4610.2010.01711.x.

2. Rains JC, Poceta JS. Sleep and headache. Curr Treat Options Neurol. 2010;12(1):1–15. https://doi.org/10.1007/s11940-009-0056-y.

3. Uhlig BL, Engstrøm M, Ødegård SS, Hagen KK, Sand T. Headache and insomnia in population-based epidemiological studies. Cephalalgia. 2014;34(10):745–751. https://doi.org/10.1177/0333102414540058.

4. Rangel TC, Falcão Raposo MC, Sampaio Rocha-Filho PA. The prevalence and severity of insomnia in university students and their associations with migraine, tension-type headache, anxiety and depression disorders: a cross-sectional study. Sleep Medicine. 2021;88:241–246. https://doi.org/10.1016/j.sleep.2021.10.029.

5. Houle TT, Butschek RA, Turner DP, Smitherman TA, Rains JC, Penzien DB. Stress and sleep duration predict headache severity in chronic headache sufferers. Pain. 2012;153(12):2432–2440. https://doi.org/10.1016/j.pain.2012.08.014.

6. Boardman HF, Thomas E, Millson DS, Croft PR. Psychological, sleep, life-style, and comorbid associations with headache. Headache. 2005;45(6):657–669. https://doi.org/10.1111/j.1526-4610.2005.05133.x.

7. Caspersen N, Hirsvang JR, Kroell L, Jadidi F, Baad-Hansen L, Svensson P, Jensen R. Is There a Relation between Tension-Type Headache, Temporomandibular Disorders and Sleep? Pain Res Treat. 2013;2013:845684. https://doi.org/10.1155/2013/845684.

8. Rains JC, Davis RE, Smitherman TA. Tension-type headache and sleep. Curr Neurol Neurosci Rep. 2015;15(2):520. https://doi.org/10.1007/s11910-014-0520-2.

9. Wang J, Huang Q, Li N, Tan G, Chen L, Zhou J. Triggers of migraine and tension-type headache in China: a clinic-based survey. Eur J Neurol. 2013;20(4):689–696. https://doi.org/10.1111/ene.12039.

10. Ong JC, Park M. Chronic headaches and insomnia: working toward a biobehavioral model. Cephalalgia. 2012;32(14):1059–1070. https://doi.org/10.1177/0333102412455709.

11. Ferini-Strambi L, Galbiati A, Combi R. Sleep disorder-related headaches. Neurol Sci. 2019;40(Suppl 1):107–113. https://doi.org/10.1007/s10072-019-03837-z.

12. Ong JC, Stepanski EJ, Gramling SE. Pain coping strategies for tension-type headache: possible implications for insomnia? J Clin Sleep Med. 2009;5(1):52–56. https://doi.org/10.5664/jcsm.27392.

13. Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119–132. https://doi.org/10.1016/S1087-0792(03)00044-3.

14. Merica H, Blois R, Gaillard JM. Spectral characteristics of sleep EEG in chronic insomnia. Eur J Neurosci. 1998;10(5):1826–1834. https://doi.org/10.1046/j.1460-9568.1998.00189.x.

15. Giamberardino MA, Martelletti P. Comorbidities in Headache Disorders. SpringerLink 2017. Available at: https://link.springer.com/content/pdf/10.1007%2F978-3-319-41454-6.pdf.

16. Engstrøm M, Hagen K, Bjørk M, Stovner LJ, Stjern M, Sand T. Sleep quality, arousal and pain thresholds in tension-type headache: a blinded controlled polysomnographic study. Cephalalgia. 2014;34(6):455–463. https://doi.org/10.1177/0333102413515339.

17. Fernández-de-Las-Peñas C, Fernández-Muñoz JJ, Palacios-Ceña M, Parás-Bravo P, Cigarán-Méndez M, Navarro-Pardo E. Sleep disturbances in tension-type headache and migraine. Ther Adv Neurol Disord. 2017;11:1756285617745444. https://doi.org/10.1177/1756285617745444.

18. Cho SJ, Song TJ, Chu MK. Sleep and Tension-Type Headache. Curr Neurol Neurosci Rep. 2019;19(7):44. https://doi.org/10.1007/s11910-019-0953-8.

19. Faizi F, Tavallaee A, Rahimi A, Saghafinia M. Psychiatric Comorbidities and Environmental Triggers in Patients with Chronic Daily Headache: A Lifestyle Study. Iran J Psychiatry. 2017;12(1):29–35. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5425349/.

20. Heckman BD, Holroyd KA. Tension-type headache and psychiatric comorbidity. Curr Pain Headache Rep. 2006;10(6):439–447. https://doi.org/10.1007/s11916-006-0075-2.

21. Juang K, Wang S, Fuh J, Lu S, Su T. Comorbidity of Depressive and Anxiety Disorders in Chronic Daily Headache and Its Subtypes. Headache. 2000;40(10):818–823. https://doi.org/10.1111/j.1526-4610.2000.00148.x.

22. Angeletti S. How to develop good media relations. Cephalalgia. 1998;18(Suppl 21):80–81. https://doi.org/10.1177/0333102498018s2120.

23. Kim J, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK. Insomnia in tension-type headache: a population-based study. J Headache Pain. 2017;18(1):95. https://doi.org/10.1186/s10194-017-0805-3.

24. Tesfaye S, Sloan G, Petrie J, White D, Bradburn M, Julious S et al. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multi-centre, double-blind, randomised crossover trial. Lancet. 2022;400(10353): 680–690. https://doi.org/10.1016/S0140-6736(22)01472-6.

25. Evers S. Special issue on headache and sleep. Cephalalgia. 2014;34(10):723–724. https://doi.org/10.1177/0333102414543504.

26. Wilson S, Argyropoulos S. Antidepressants and Sleep. Drugs. 2005;65(7):927–947. https://doi.org/10.2165/00003495-200565070-00003.

27. Burchakov DI, Tardov MV. Insomnia in general practice: the role of doxylamine. Meditsinskiy Sovet. 2020;(2):45–53. (In Russ.) https://doi.org/10.21518/2079-701X-2020-2-45-53.

28. Shavlovskaya OA. Use of the drug Donormil (doxylamine) in clinical practice. RMJ. 2011;30:1877. (In Russ.) Available at: https://www.rmj.ru/articles/nevrologiya/Primenenie_preparata_Donormil_doksilamin_v_klinicheskoy_praktike/.

29. Кочетков АГ, Лянг ОВ, Масенко ВП, Жиров ИВ, Наконечников СН, Терещенко СН, Методы статистической обработки медицинских данных. М.: РКНПК, 2012. 42 с. Режим доступа: https://medstatistic.ru/articles/Metody_statobrabotki.pdf.

30. Korabelʹnikova EA, Zhuravleva MV. Sleep Disorders and Headache: Correlation and Mutual Influence. Effective Pharmacotherapy. 2019;15(39): 36–46. (In Russ.) https://doi.org/10.33978/2307-3586-2019-15-39-36-46.

31. Ødegård SS, Engstrøm M, Sand T, Stovner LJ, Zwart JA, Hagen K. Associations between sleep disturbance and primary headaches: the third Nord-Trøndelag Health Study. J Headache Pain. 2010;11(3):197–206. https://doi.org/10.1007/s10194-010-0201-8.

32. Peever JH, Sessle BJ. Sensory and motor processing during sleep and wake-fulness. In: Principles and practice of sleep medicine. Elsevier; 2017, рр. 239–249. Available at: https://neupsykey.com/sensory-and-motor-processing-during-sleep-and-wakefulness/.

33. Ødegård SS, Omland PM, Nilsen KB, Stjern M, Gravdahl GB, Sand T. The effect of sleep restriction on laser evoked potentials, thermal sensory and pain thresholds and suprathreshold pain in healthy subjects. Clin Neurophysiol. 2015;126(10):1979–1987. https://doi.org/10.1016/j.clinph.2014.12.011.

34. Koreshkina MI. Anxiety disorders as a risk factor for sleep disorders and headaches. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2021;121(2):131–135. (In Russ.) https://doi.org/10.17116/jnevro2021121021131.